There is an article floating around the usual suspect far left wing publications in the United States northwest apparently trying to describe incorrectly the observed vs. admitted issue in United States Medicare. Or perhaps it's trying to explain Medicare skilled nursing facility (SNF) coverage rules. Or maybe the article has something to do with rehab.
To be honest, I am not sure what the author's agenda is but her article is full of errors and misstatements and outright nonsense. In particular, as to the third paragraph, the author -- a journalism professor -- writes of her mother:
"Even though she is on Medicare, her care center stay is not covered. Why? Because the hospital declared her first night as "observation." She was admitted at 2:25 a.m., thereby missing the (E1)"two midnights" requirement for Medicare to pay for the (I:) usual next step for seniors after discharge: rehabilitation. (E2) If a patient is admitted for that minimum, he or she is (M1) eligible for 100 days of skilled nursing care. Because my mother was not, (M2) we pay out-of-pocket."
Just to set the record straight (see image above from medicare.gov or read more for all the details):
E1: There is no “two midnights” requirement in Medicare related to rehabilitation (but see numbers 2 and 5 below)
E2: There are six – not one -- requirements for SNF care coverage under Medicare; one of them is that the patient first be admitted to – not observed at -- an acute care hospital for “three days not counting the day of discharge,” not “two midnights.” (The author is apparently confused because there is a new “two midnight” auditing protocol now being tested by Medicare that has nothing to do with SNF care coverage. But If the test were to result in the two midnight rule becoming law and did change SNF care coverage rules, it possibly would have favored the person's mother, not harmed her. )
M1. To keep Medicare SNF care coverage once at the "care center" there are multiple extensive additional requirements to meet – which are checked weekly or even daily -- once a Medicare patient is transferred to a “care center” for skilled nursing/rehabilitation; if those multiple requirements are continually met, the patient could receive UP TO 100 days of PARTIALLY covered skilled nursing care before Medicare coverage ends
M2: Everyone – not just this person's mother -- in a SNF under Medicare coverage for more than 20 days – including everyone that meets all six requirements to get into a SNF under Medicare and all daily or weekly continuing requirements to maintain the Medicare coverage once there -- pays out of pocket. This complaining woman was not unique in having to pay out of pocket. All of us on Medicare have to pay out of pocket for everything, beginning with 45-50 years of premium prepayment and usually a monthly premium once on Medicare, all of which only covers half our costs on average (almost all of us arrange fior tertiary -- usually private -- supplemental insurance that pays some of the out of pocket costs).
I1: The sentence about rehabilitation being the “usual next step for seniors after discharge” makes no sense. I would guess that the next step is usually “go back to the surgeon in a week” or… “call me if it gets infected…” or... But even if the author is correct, the rehab is usually given at home or outpatient so what does that have to do with the rest of the article? Or the two midnight rule? Or any of the author's other blather about a law that would just make the situation worse and actually bake into legislation exactly what the author is complaining about. All I can deduce is that the journalist wants United States Medicare to pay for her mother's daily living costs. Elsewhere in the article she says the mother will never get out of the home and needs 24x7 custodial care.
E2: There are six – not one -- requirements for SNF care coverage under Medicare; one of them is that the patient first be admitted to – not observed at -- an acute care hospital for “three days not counting the day of discharge,” not “two midnights.” (The author is apparently confused because there is a new “two midnight” auditing protocol now being tested by Medicare that has nothing to do with SNF care coverage. But If the test were to result in the two midnight rule becoming law and did change SNF care coverage rules, it possibly would have favored the person's mother, not harmed her. )
M1. To keep Medicare SNF care coverage once at the "care center" there are multiple extensive additional requirements to meet – which are checked weekly or even daily -- once a Medicare patient is transferred to a “care center” for skilled nursing/rehabilitation; if those multiple requirements are continually met, the patient could receive UP TO 100 days of PARTIALLY covered skilled nursing care before Medicare coverage ends
M2: Everyone – not just this person's mother -- in a SNF under Medicare coverage for more than 20 days – including everyone that meets all six requirements to get into a SNF under Medicare and all daily or weekly continuing requirements to maintain the Medicare coverage once there -- pays out of pocket. This complaining woman was not unique in having to pay out of pocket. All of us on Medicare have to pay out of pocket for everything, beginning with 45-50 years of premium prepayment and usually a monthly premium once on Medicare, all of which only covers half our costs on average (almost all of us arrange fior tertiary -- usually private -- supplemental insurance that pays some of the out of pocket costs).
I1: The sentence about rehabilitation being the “usual next step for seniors after discharge” makes no sense. I would guess that the next step is usually “go back to the surgeon in a week” or… “call me if it gets infected…” or... But even if the author is correct, the rehab is usually given at home or outpatient so what does that have to do with the rest of the article? Or the two midnight rule? Or any of the author's other blather about a law that would just make the situation worse and actually bake into legislation exactly what the author is complaining about. All I can deduce is that the journalist wants United States Medicare to pay for her mother's daily living costs. Elsewhere in the article she says the mother will never get out of the home and needs 24x7 custodial care.
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